Diseases can have a variety of causes, but a major cause is health-risk behaviors, such as smoking, alcohol consumption, poor nutrition, lack of physical exercise, risky sexual practices, and ignoring preventive health screenings. Moreover, many people try to cope with stress by regulating their emotions through health-impairing activities. For example, they might attempt to calm down by smoking or taking drugs. People often distract themselves from stressful encounters by resorting to behaviors that may alleviate discomfort in the short run, but at the expense of health in the long run. Public health efforts continually aim to reduce risk behaviors, which has produced some progress in this regard. There are many reasons – some personal, others social – why risk behaviors are attractive and persistent. Therefore, no single public health strategy can counteract them all effectively. This chapter will focus on individual determinants of behavioral change, although environmental conditions also deserve attention. A few introductory remarks will provide the context for this analysis.

Health behaviors in the context of macrosocial change

We live in a world that is characterized by rapid and uncertain macrosocial changes. In Europe, for example, the breakdown of the communist system, the economic recession, and the large influx of immigrants have created a great deal of social stress. The hardships of migration, unemployment, and poverty foster drug use, crime, and risky health habits. The growth of multiethnic and disadvantaged populations displaced from their native countries places additional strains on national and local public health systems.